四项评分法对输卵管妊娠保守治疗效果的预测价值  

The Value of Quadrinomial Scoring Method in Predicting Tubal Pregnancy's Outcome

作　　者：祖月娥[1] 蒋学风[2] 罗新[2] 王文慧[2] 黎清[2] 王晓玉[2] 谢杏美[2] 徐建平[2] 

机构地区：[1]长沙市妇幼保健院,湖南长沙410007 [2]暨南大学附属第一医院,广东广州510630

出　　处：《实用妇产科杂志》2008年第5期291-294,共4页Journal of Practical Obstetrics and Gynecology

摘　　要：目的：了解输卵管妊娠四项评分法对输卵管妊娠保守治疗效果的预测价值。方法：根据输卵管妊娠四项评分表并以Elito评分表作对照,对122例拟行保守治疗的输卵管妊娠进行评分,采用甲氨蝶呤联合米非司酮进行保守治疗并追踪治疗结局。结果：在122例中,保守治疗成功98例,失败24例,成功率80.3%。从ROC曲线得出8分值敏感度和特异度之和最大,是预测保守治疗失败的临界点,准确度为91.0%,阳性预测值达71.0%,四项评分法准确度显著高于Elito评分表（91.0%vs84.4%,P〈0.05）。对保守治疗成功与失败两组进行比较,发现血清β-HCG〉5000U/L、孕酮（P）〉47.55nmol/L、阴道彩超血流呈半环-环状有统计学意义（P〈0.01）。结论：输卵管妊娠四项评分≥8分能有效预测输卵管妊娠保守治疗失败的病例。血清β-HCG〉5000U/L、P〉47.55nmol/L、阴道彩超血流呈半环-环状是评估保守治疗失败的的重要指标。Objective： To assess the value of quadrinomlal scoring method in predicting outcome of non,surgical treatment of tubal pregnancy.Methods： 122 cases of tubal pregnancy were scored before receiving MTX and RU486 with quadrinomlal scoring method and compared with the results from Elito scoring table. Results：98 cases recovered after non,surgical treatment and 24 cases turned to surgery. The success rate is 80.3%. The scoring value of 8 have the highest sensitivity and specificity, it can be regarded as cutoff point of predicting the failure of nonsurgical treatment, achieving an accuracy of 91.0% and positive predictive values of 71 .0%, which was significantly more accurate than Elito scoring table （91,0% vs. 84.4%, P〈0.05）. Serum β-HCG≥5000 U/L,P≥47,55 nmol/L and blood flow ring 1/2-1 showed from transvaginal color Doppler sonography （TVCDS） play a critical role in predicting failure of nonsurgical treatment（ P 〈 0.01 ）, Conclusions： Quadrinomial scoring value ≥ 8 can effectively predict the failure of nonsurgical treatment in tubal pregnancy, Serum β-HCG≥5000 U/L, P≥47,55nmol/L and 1/2-1 blood flow ring under TVCDS are important predictive factors in the outcome of tubal pregnancy with nonsurgical treatment

关 键 词：输卵管妊娠 保守治疗 预测 

分 类 号：R714.221[医药卫生—妇产科学]